It is well known that dental caries and periodontal infections are the two main diseases of the oral cavity. Within each disease there are recurrent forms. Even with outstanding patient education and vigilant recommendations in plaque control we still see abundant caries and ubiquitous forms of periodontal disease. Sometimes, it even seems as if we see more forms of disease than we do of health. Treating these two diseases is a never-ending battle.

It is the author’s opinion that the dental community needs a major revolutionary shift in how we have treated these diseases. Purely from an historical perspective, we have not been very successful. Enter… “Ozone Therapy”.

What is ozone?
To understand ozone therapy one must review a little, simple, science. Don’t worry, it’s not Inorganic Chemistry! Oxygen has a valence of two, i.e. O2. Ozone is an activated, trivalent (three atoms) form of oxygen. It’s simply supercharged oxygen, i.e. O3. It is also a strong anti-oxidant. (A big buzz-word for the 21st century.)
Ozone is produced constantly in the upper atmosphere, as long as the sun is shining. When it falls downward to earth, because it is heavier than air, it combines with any pollutant it contacts and literally cleans the air-it is Mother Earth’s natural way of self-cleaning. Medical Ozone is made when Medical Grade Oxygen is electrically activated (using an Ozone Generator) to form Ozone.

The first ozone generators were developed in Germany in 1857 and in 1870 it was used therapeutically to purify blood. In 1881, there is evidence that it was used as a disinfectant while treating diphtheria. In October 1893, Ousbaden, Holland became the first city utilize a water treatment plant using ozone and today there are over 3000 municipalities around the world that use ozone to clean water and sewage. In 1885, the Florida Medical Association published “Ozone” detailing the use of ozone for therapeutic purposes. Ozone was used to treat tuberculosis, anemia, whooping cough, asthma, bronchitis, hay fever, pneumonia, and diabetes, just to name a few diseases, back in 1911. During WWI ozone was used to treat wounds, gangrene and the effects of poison gas.

Two of the most historical notes are: 1) the use of ozone in dentistry began in 1932 and in 1933; and 2) the American Medical Association set out to destroy all ozone related medical treatments that competed with drug therapy. The suppression of ozone therapy began then, and it continues to this day in the U.S. It is clear that this therapy has been around a while; however, it is only now becoming remarkable and significant.

How ozone works:
The oxidizing effectiveness of ozone is well documented and can be produced in a controlled manner using electrical corona discharge units. More importantly, ozone is extremely effective at reducing the amount of bacteria and viruses present in water and air. It can oxidize many organic compounds and is a powerful germicide. This is where its application in dentistry is unparalleled.

Caries is troublesome for the dental practitioner!
It is known that caries diagnosis is not an exact science. The use of a mirror, explorer and x-rays have not proven very accurate at definitively diagnosing caries; just ask five dentists their opinion about a carious lesion and you are bound to get five different diagnoses and possibly five different treatment modalities. More importantly, the dental profession and pharmaceutical companies are still perplexed to find the ideal modality that can prevent or cure caries. We try with better computerized analysis of digital radiographs, the use of dyes, and other technologies. Fluorides, without a doubt, reduce the incidence and prevalence of decay; however, we still see ubiquitous amounts of decay on a daily basis.

Ozone therapy in dentistry:
One must first revisit and understand cariology and plaque biofilm to understand how ozone therapy works. We all recall the caries process: plaque microorganisms and sugar substrate produce acid which, when left in contact with a susceptible tooth, demineralizes enamel. It is now thought that a possible failure to cure dental decay may be due to the change in the type and species of microorganisms in carried development. (Reference*)

Periodontal microorganisms are just as elusive and their complexity in numbers and quality makes treating periodontal disease a true nemesis.

Both caries and periodontal disease are caused primarily by plaque biofilm. Research has shown that decay starts in this bio-film above the tooth surface. The acids released by these bacteria - and there are over 450 species in a mature carious cavity - dissolve out the minerals of our tooth, cause a cavity, and then infect the inner structure of the tooth. Some bacteria are very aggressive and virulent,m and their by-products found in the really huge lesions or cavities need more than just a single 40-second ozone treatment; and by this stage, conventional dental care - and yes that means drilling and filling at some stage - is still the best way to go when combined with ozone treatment.

Why? - well, you don't have to drill all the tooth out, as you can sterilise the 'infected' part, and let it remineralise. Once remineralised, the tooth will be stronger, and has not been weakened by the removal of it's bulk or structure.

Some bacteria are very aggressive and virulent - so conventional 'drugs' do not work. You need ozone to destroy them and their by-products

If we know we must deal with disease at the basic cellular level of the organism, it stands to reason that anything that can kill the bacteria, virus and fungi would be revolutionary. This is what ozone technology accomplishes.

Under the leadership of Professor Edward Lynch at Belfast University, published studies have shown that with just ten seconds of exposure of ozone to the root caries lesion, 99% of microorganisms were eliminated and over 70% of the lesions studied reversed or improved and the remainder did not progress. (See Overview of Dental Decay)

Part of the research into ozone technology was to look at a reliable and reproducible way to measure decay. The diagnodent ™ (Kavo) has been available for over four years now and works by shining a laser at the inside of tooth surface. It detects bacterial contaminants and indirectly measures the degree of decay. (Its validity and reliability are without question….Editor:) The level of decay is expressed as a number on the screen and as an audible tone. The higher the number and pitch tone, the larger the area of decay. This is exceptionally beneficial for patient-operator co-discovery and diagnosis. What the machine actually measures is the fluorescence of bacteria and indirectly, the density of tooth structure and the presence of decay.

The actual procedure: Ready, Set? Done!
Kavo Dental Ltd distributes the HealOzone Unit and a new unit is now available from O3, a South African company. It's Clinical Director is none other than Dr Julian Holmes, one of the original research team. Both units deliver on average, a 60-second burst of ozone gas, at a pre-set concentration, through a hose and handpiece, into a polymer cup that creates a seal on the tooth surface. Without the seal the unit is incapable of producing ozone gas. It must be stated that ozone is a substance that needs to be carefully controlled, as higher concentrations at ground level have been known to cause respiratory distress.

To complete the treatment, a fluid/mineral wash is placed over the treated surface, or into the treated site (if necessary, the patient's own saliva could be used-as there are minerals and fluoride in it). This wash kick-starts the remineralization process. This only takes five seconds further. The patient is sent home after about twenty-five seconds per tooth with an “at-home kit” that contains fluoride toothpaste and mouthrinse.

In just about 25 seconds the HealOzone eliminates 99% of the microorganisms that cause decay. The healing process begins immediately, as remineralization takes over. This “naturally restored” tissue is far more resistant to decay. Here is the best part: there is virtually no pain to the patient and no anesthesia!

The bottom line:
The repetitive nature of tooth decay and repair is disheartening and discouraging. Decay often begins as a lesion that is diagnosed with an explorer, mirror and radiograph, which is treated with amputation of the diseased tooth with a conventional handpiece and filled with a composite or other restorative material. Approximately ten to fifteen years later, recurrent decay is often noted and the restoration and new lesion are again amputated and a larger restoration placed. Fifteen years after that, recurrent decay may be noted, however, now it extends into the pulp chamber and root canal therapy is instituted and a crown fabricated. The point is: what would be if an initial lesion were initially prevented? What would dentistry be like if original lesions were not amputated but remineralization of enamel took place and the tooth was made more impenetrable to acid attack? This is a possibility and it is happening now with ozone therapy!

So, if you are one who likes to “stay in your box” and will admit to having a hard time adjusting to change, ozone therapy requires you to take a hard look at your current paradigm. Ozone treatment will be revolutionary in dentistry; it is high time the dental community treat it as such. Learn about it and be part of the modernization of dentistry! (See websites for further information.)